I had an acutely psychotic patient with an order for IV Haloperidol....
I went to the pyxis...selected haloperidol lactate...it dispensed the med. In reading the vial, it stated "FOR IM ADMINISTRATION ONLY". Great...I thought I had selected the wrong medication...checked the screen...dispensed med was haloperidol lactate. So, I called the doctor and got the route changed to IM administration instead. I emailed pharmacy and told them of the potential problem. The reply I got was...it is ok to use for IV administration. WHAT??!! The vial states NOT FOR IV ADMINISTRATION, FOR IM ADMINISTRATION ONLY!!!! I am NOT GOING TO GIVE IT IV!
HELP:uhoh3: !!! Is this RPh nuts?? I've checked drug guides, the FDA website...anywhere and everywhere....and I can't find a clear answer, so any help you can give me would be greatly appreciated!!!
I work in an ICU and we use Haldol IV all the time. It's one of the more frequently ordered drug for severe agitation when ativan/versed, etc. are not effective. Usually the order will read 5mg Haldol IV Q 1 hour. The vials we use say "For IM use only". I've questioned this as well in my unit only to hear "it's always been given". I do monitor my patients for changes in the QT interval and have seen Haldol significantly prolong the QT interval.
The manufacturer is covering his butt by putting IM only on the vial. The hospital is covering their butt by making policies in regards to Haldol IV. And yet I still see nurses give Haldol IV "cause thats what the MD ordered" "the Pharmacist said it was OK". Protect yourself, always.
I don't think off label use would be a consideration for this route override issue. Therapeutic effect/desired effect is the same just more timely IV. Risk vs. benefit, how much risk are you willing to take?
LilRedRN1973
1,062 Posts
I work in an ICU and we use Haldol IV all the time. It's one of the more frequently ordered drug for severe agitation when ativan/versed, etc. are not effective. Usually the order will read 5mg Haldol IV Q 1 hour. The vials we use say "For IM use only". I've questioned this as well in my unit only to hear "it's always been given". I do monitor my patients for changes in the QT interval and have seen Haldol significantly prolong the QT interval.
Melanie = )